Provider Demographics
NPI:1003935164
Name:LILJE, WILFRED (CATC, RRW)
Entity Type:Individual
Prefix:MR
First Name:WILFRED
Middle Name:
Last Name:LILJE
Suffix:
Gender:M
Credentials:CATC, RRW
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:LILJE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CATC
Mailing Address - Street 1:4900 SERRANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3301
Mailing Address - Country:US
Mailing Address - Phone:818-347-1577
Mailing Address - Fax:818-347-0184
Practice Address - Street 1:4900 SERRANIA AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-3301
Practice Address - Country:US
Practice Address - Phone:818-347-1121
Practice Address - Fax:818-347-0184
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA081794225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA081794OtherCAADE
CA7364-1095OtherAMERICAN PSYCHOLOGICAL ASSOCIATION
CARW1300OtherCCBADC